Report critical of state prison's health care

A year-long study of health care in Michigan's prisons paints a picture of an inefficient, overly bureaucratic system that is too costly and delivers inferior care.

The report by the National Commission on Correctional Health Care, released today, lists 56 recommendations on how the Michigan Department of Corrections can improve the medical and mental health care of inmates. Corrections Director Patricia Caruso, in a separate response to the Legislature, said her department already is implementing many of the study's recommendations.

"The medical program has a somewhat complicated structure," said the independent report, commissioned a year ago by Gov. Jennifer Granholm, following newspaper reports of inferior health care in the prisons.

Among other problems, the report noted that nurses and dentists are Corrections Department employees, while doctors and physicians assistants work for an independent contractor, Correctional Medical Services (CMS).

The CMS physicians are unaccountable to the state employees, the report said. It urged the Corrections Department to do a better job of monitoring its contract with CMS.

The report said one medical service provider employed by CMS appeared to have a problem with "cognitive functioning," did not seem to understand questions asked by those conducting the study and had problems operating the prison's electronic health records system.

"There were obvious implications for patient safety in this situation," the report said, noting that several staff members were aware of the provider's shortcomings but nothing was done about it.

"Apparently, it is not clear to the people in this system who is in charge and how change can be effectuated," the report found. "Any system can have, from time to time, an employee with a functional impairment.

"What is frightening here, however, is that the system failed to self-correct. Part of the problem is that the providers are not employees. None of the supervisors our physician spoke with felt they had the power to correct this situation."

The report also noted prescriptions often go unfilled. The computerized medical records system often contains false information about patients, the report said.

The Department of Corrections may be violating federal environmental laws by incinerating some unused prescriptions, the report said.

In the letter to legislators, Caruso called the report and her department's response "two critical milestones on the department's path to creating a culture of quality in the prison health care system."